PROJECT SUMMARY The incidence of chronic pain rises dramatically during adolescence and results in changes that disrupt normative developmental trajectories, as reflected in missed schooling, withdrawal from social activities, family dysfunction, and overdependence on parents. While there is strong empirical support for the initial and short- term impact of adolescent chronic pain, little is known regarding the life course consequences. Determining the long-term impact of adolescent pain is critical for informing targets of preventative interventions, lessening suffering, and promoting positive adjustment in adulthood. The specific aims of this project are to (1) determine the long-term impact of adolescent chronic pain on developmental and health outcomes in young adulthood (Study 1) and (2) identify intraindividual (e.g., anxiety) and interindividual (e.g., family functioning) vulnerabilities in adolescence that amplify risk for adverse outcomes (Study 2). We will take an integrative approach to examine key transitional outcomes of young adulthood: (1) educational achievement, (2) vocational achievement, (3) peer and romantic relationships, (4) independent living, (5) general health status, (6) chronic pain symptoms, and (7) transition to adult medical care. The project aims will be accomplished through completion of two complementary studies during the applicant's two-year fellowship period. Study 1 is a secondary data analysis of the National Longitudinal Survey of Adolescent to Adult Health to examine adolescent chronic pain (Wave I and Wave II) as a risk factor for adverse young adult outcomes (Wave III). Study 2 involves a new follow-up data collection of 140 young adults (ages 18-25) who, during adolescence (ages 11-17), participated in a prior NIH-funded randomized controlled trial of an internet-delivered pain management program. We will leverage data from the prior trial's baseline assessment of pain and intrapersonal and interpersonal vulnerabilities to predict current health and development in young adulthood. In combination, these studies represent a unique opportunity to determine the extent to which adolescents with chronic pain are at risk for long-term adversities, and identify early vulnerability factors that may influence poor outcomes. The planned research and corresponding training activities under this two-year postdoctoral fellowship award will allow the applicant to build expertise in developmentally-grounded pediatric pain research and advanced longitudinal cohort design and analysis. Training will also focus on grant writing and scholarly productivity in the field of pain. Attainment of this Ruth L. Kirschstein National Research Service Award will support the applicant in developing the scientific and leadership skills necessary to build an independent research career and a promising new program of science on the life course consequences of pediatric pain, with the ultimate goal of advancing clinical care and lessening the economic and social impact in adulthood.